PaedBits

This information is intended solely for education purposes. It is in no way intended to be medical advice. Should you require medical advice, please contact your child’s doctor.

Cow’s Milk Protein Allergy (CMPA) is the commonest food allergy in infants. Not to be confused with lactose intolerance.

Symptoms can include:

Symptoms of severe allergy or anaphylaxis include swelling of face/tongue/lips/throat, hoarse voice, breathing difficulty, dizziness, lightheadedness, fainting, lethargy, loss of consciousness. If there are any of these symptoms, call the local emergency service (i.e., 911)/go to ER.

Under advice and supervision of a doctor, treatment of CMPA includes a 2 week trial of:

Most children grow out of CMPA and milk can be re-introduced at a later date that can be discussed with the child’s doctor.

This information is intended solely for education purposes and is in no way to be substituted medical advice. If you have concerns about reflux in your baby, take your baby to their doctor.

In simple terms, their gut is still immature.

The mouth is connected to the stomach through the esophagus, essentially a tube lined with muscle. In adults, the esophagus is longer and has something called a “lower esophageal sphincter” (LES) at the bottom before it enters the stomach, which prevents food from moving back up.

In babies, the esophagus is shorter, the muscle has not fully matured and the LES has not fully developed yet, so food easily moves in both directions. When food moves up the esophagus, it can cause discomfort. Many babies with reflux are happy and do not have symptoms. In fact, they may even feel relief once they spit up.

For these reasons, keeping your baby upright after meals uses gravity to help keep food moving downward.

If your baby has symptoms of severe reflux, including arching their back, discomfort or crying with feeds or not gaining weight, they may have gastro-esophageal reflux disease and your doctor can help.

Reflux symptoms tend to get better as the gut matures overtime, and also around 6 months, as your baby is sitting more and eating more solids.

5 factors that can contribute to reflux:

1. Overfeeding – consider feeding smaller amounts more frequently
2. Gulping in a lot of air – consider burping at regular intervals
3. Position – lying down too soon after a feed, consider keeping elevated at least 30 min-1h after a feed
4. Age (due to maturity of the gut) – generally resolves with maturity of muscles and sitting upright
5. Fluid vs. solids – The younger they are, they drink mainly fluids. Reflux tends to get better with solid food introduction.

This post is intended to be educational. This is in no way to be used in place of medical advice. Please see your doctor if you require medical advice.

Iron is a mineral found in our bodies, which allows oxygen to be transported to our organs, for optimal functioning. In children, it is also vital for growth and brain development.

A deficiency of iron can lead to problems with weight gain, reduced energy levels, difficulty with concentration and can affect school performance.

Risk factors for iron deficiency include: being preterm, inadequate iron in the diet, excess dairy milk intake, among others.

If you have any concerns about iron deficiency, you should make an appointment to see your child’s paediatrician/doctor, as your child will need to be examined, potentially have blood tests or start supplementation.

If your doctor has recommended iron, have your child take iron with a source of vitamin C as this increases absorption. Avoid iron being taken with dairy milk as it can disrupt absorption.

Breastmilk for the first 6 months, or, alternatively iron-fortified formula from birth to the time dairy milk is started. Other foods that contain iron include meats, lentils, leafy green vegetables and legumes. It is important to limit dairy intake to 500-750mL/day as higher dairy intake can lead to iron deficiency. If starting solids, start with iron-rich foods.

1. Hand-washing! Here is a link to a video of the steps involved in handwashing in song form! https://youtu.be/GAP8HZdV5Qo
2. Avoid having visitors or visiting others who are unwell.
3. Vaccinations:
   1. It would be wise to ensure visitors are also fully up to date on their vaccinations. Here’s a reason why: the reason we get immunized against perstussis (whooping cough) is so that we can protect babies (that is, prevent them from getting it). Pertussis can make babies very unwell.
   2. Flu shot! Ensure all eligible family members are vaccinated with the flu vaccine every year. Babies under 6 months cannot be vaccinated, so they rely on those who surround them being protected (this is called cocooning). Breastfeeding once you have had the flu shot can also transfer immunity. Pregnant women should also get the flu shot during their pregnancy to confer immunity.
4. Tetanus, Diphtheria and Pertussis Booster: Pregnant women should get the booster during their pregnancy.
5. Anyone who has cold sores should not kiss the baby. Cold sores occur due to a virus that has the potential to cause severe disease in babies.

This post is intended to be an opinion piece and should not be used as medical advice. Should you or your child require medical advice, please contact your doctor.

It’s no secret human breastmilk has many benefits for human babies, including the obvious fact that milk that comes from the same species is generally nutritionally ideal for the offspring.

That being said, formula is an excellent source of nutrition for our babies, and mothers should not be made to feel guilty or as if they have failed should they decide to supplement or exclusively formula feed their babies.

For healthy child development, mothers should ideally be happy and healthy. Her partner and family members, friends and community should come together to support her. As they say, “it takes a village”.

This is intended to educate and is in no way a substitute for individualized medical advice. Speak to your child’s doctor for individualized medical advice.

How do I know if my baby is ready to start solids?

The CPS and AAP, as well as WHO recommend exclusive breastfeeding for 6 months, and sometimes there is confusion about when to start solids. This is because the latest research shows starting foods that cause allergy (allergenic foods) earlier (4-6 months), if there is a family history of allergies, is likely to reduce the risk of your child developing food allergies.

Signs of readiness:

1. Showing interest – it’s important your baby is showing signs of interest. Watching you eat, reaching out to try to eat, opening their mouths, grabbing your food/dishes, are all signs they may be interested. This along with being able to turn their heads away or show you they are not interested is also important. The key is, the feeding experience should be nice for both of you, and these two things – showing interest, and being able to turn away (or your being in tune with them not being interested anymore) – can prevent force-feeding that can have longer term implications.
2. Able to sit upright and keep their head up – To protect the airway, you want to ensure your baby is sitting upright and able to keep their head up on their own. We wouldn’t eat food lying down due to risk of choking – a baby shouldn’t either.
3. Opening their mouths when you approach with a spoon  – it’s important your baby opens his/her mouth when approached with a spoon, as a sign of showing interest. If he or she is not doing this, remember, you can try again another time, but what is key is not to press the issue.

What to start with?

Start with iron-fortified food, including infant cereal, leafy green vegetables, lentils, beans, or meats. Fruits can also be introduced at this time. Once you have introduced various foods and they are tolerated, start considering introducing allergenic foods. We started with peanut butter – a small, rice grain sized bit of peanut butter mixed in her organic oatmeal cereal. Monitor for rash and other signs of allergy. I think a good rule of thumb is to introduce one allergen for at least three days before moving onto another allergen, because this way, if there is a reaction, it is easier to discern what could be causing it.

Once an allergenic food is introduced, keep introducing it regularly. We try to do this once or twice a week once we have introduced it, although it sometimes becomes challenging to keep track of and we have often found ourselves doing so once every couple of weeks. A helpful tool is to create a weekly and even monthly schedule.

How do I prepare the food?

If you plan on introducing foods at 4 months, pureed foods would be best. We introduced infant cereal and pureed foods. By 6 months, we started baby led weaning, as babies are able to tolerate various textures at this age. Always check with your child’s doctor. Ideally, you want to introduce as many textures as possible by 9 months so your baby is likely to keep an open mind to a greater repertoire of foods.

What are allergenic foods?

Peanuts, tree nuts (like almonds), fish, shellfish, soy, wheat, dairy, eggs.

How to introduce dairy?

Milk is not recommended before at least 9 months of age. However, given that dairy is a potential allergen, you can introduce yogurt and cheese.

• Another important thing to remember is a mother can eat allergenic foods during pregnancy and if she chooses to/is able to breastfeed. These are thought to help reduce risk of allergy development in those who have a family history of allergy.